Why doctors should not ask patients about guns: A conservative case

Should doctors ask patients if they own guns? Currently, ObamaCare bans the federal government from using patient medical records to compile a list of gun owners. But following the Newtown, CT shootings, President Obama issued an executive order clarifying that “the Affordable Care Act [ObamaCare] does not prohibit doctors asking their patients about guns in their homes.” The American Academy of Pediatrics (AAP) similarly encourages physicians to ask patients if they own firearms — in the name of protecting child safety. As a physician, I consider this advice misguided. Instead, physicians should not routinely ask patients whether they own guns, because it could compromise the integrity of the doctor-patient relationship.

First, the American Academy of Pediatrics is not politically neutral in the gun debate. The AAP supports standard Left positions, including “federal firearms legislation that bans assault weapon sales and the sales of high capacity magazines” and “the strongest possible regulations of handguns for civilian use.” The AAP also recommends that parents “NEVER have a gun in the home” (“NEVER” capitalized in their statement). Their website also cites the now-discredited 1986 claim that, “A gun kept in the home is 43 times more likely to kill someone known to the family than to kill someone in self-defense.”

However, numerous scholars have noted that most of those unfortunate deaths were suicides that would have likely still occurred even if no gun had been available. David Kopel of the Independence Institute observed that after excluding such suicides, the ratio was closer to 2-to-1. Furthermore, comparing numbers of accidental or unlawful deaths to justified deaths of criminals is misleading, because it fails to include many nonlethal self-defense uses of firearms. Depending on the source, there are 800,000 to 2.5 million defensive gun uses each year where law-abiding gun owners deter criminals without firing a shot (let alone killing the bad guy).

As Kopel noted, we don’t measure the efficacy of the police by the number of criminals killed, but by how well they stop crime. Similarly, the value of civilian-owned guns should not be measured by the number of dead intruders, but rather by crimes prevented and lives saved. The flawed 43-to-1 statistic vastly underestimates the lifesaving value of guns for law-abiding homeowners.

University of Chicago economics professor Steven Levitt has also warned about excessive fear mongering about gun ownership. In their best seller Freakonomics, he and co-author Stephen Dubner note that a child is 100 times more likely to die in a swimming accident than a gun accident.

Yet the AAP does not tell parents to “NEVER bring your child to a swimming pool,” nor does it advocate “the strongest possible regulations of swimming pool ownership.” Rather, it recommends that parents supervise children around swimming pools and follow basic rules of water safety. The AAP correctly recognizes that a home swimming pool can be a genuine value to a family, provided that parents and children follow proper precautions. Similarly, a gun can be a genuine value to responsible homeowners, provided that parents and children follow proper precautions. With both swimming pools and firearms, homeowners should determine for themselves whether the benefits outweigh the risks for their particular circumstances.

The AAP also supports teaching children how to swim, whether or not they have a pool at home. This is just common sense. Children might encounter swimming pools when visiting friends or neighbors. Similarly, doctors should recommend that children learn basic principles of firearms safety appropriate for their age, whether or not their parents own a gun, because children may still encounter firearms at neighbors’ or relatives’ houses. Parents interested in learning more on this should visit websites like GunProof.org.

Furthermore, law-abiding gun owners will likely view being asked about guns as an unwarranted intrusion on their privacy. No Congressman is proposing anti-swimming pool legislation, whereas powerful political forces are seeking to curtail Americans’ gun rights. Although the law does not yet allow the government to harvest gun ownership information from medical records, many gun owners are concerned such information may not remain private. The Washington Post reported that gun control groups are already lobbying to allow compilation of gun ownership data from medical records for research purposes. Plus, electronic medical records are already valuable targets for malicious hackers. Many gun owners fear becoming targets if their information falls into the wrong hands, just as some legal gun owners were apparently targeted for burglary after a suburban New York City newspaper recently published their names and addresses seeking to “out” them.

Doctors already have a professional and legal responsibility to notify the authorities if they believe patients pose an imminent threat to others or themselves. But routine inquiry about gun ownership goes far beyond this obligation. Such inquiries will instead only offend and alienate many responsible gun owners, compromising the trust essential to the doctor-patient relationship. Doctors should not put themselves in a position where patients view them as willing (or unwitting) agents of the government working against their interests.

The law should neither prohibit nor mandate that physicians ask about guns. Both would violate doctors’ rights to free speech. Hence, I disagreed with the now-overturned Florida law that had prohibited physicians from asking patients about gun ownership. But as matter of good professional practice, doctors should not routinely ask. And if doctors work for hospital systems that ask this question, they should defend and support their patients who decline to answer.

A local colleague, Dr. Matthew Bowdish, has declared, “I will not undermine the Second or Fourth Amendment rights of any of my patients who are lawful gun owners. Nor will I record my patients’ gun ownership status in any medical records that could be accessed by government officials unless relevant to a specific medical issue.” This should be the credo of all freedom-loving physicians.

Paul Hsieh is a radiologist and co-founder of Freedom and Individual Rights in Medicine. This article originally appeared in Forbes.

Physician Coaching by KevinMD

Why doctors should not ask patients about guns: A conservative case 11 comments

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PaulArkay

The psychological discomfort caused to gun owners, as a whole, when doctors ask about gun ownership is of less value than the value of one life that is lost to a gun accident.

If your patients seriously believe you are an agent of the government working against their interests, I would consider a referral to a mental health professional.

Asking about firearms in the home does not restrict anyone’s right to bear firearms, in any way.

OldeStyleLiberal

I had a doctor ask me about guns once. I was OK with that. We shoot in the same pistol competitions and he wanted to know how I avoid stovepipe ejection failures with my Col .45 Gold Cup. (ans: I have an extended ejector.)

NormRx

Let’s see, we have Waco, Ruby Ridge, drug running by the CIA, the CIA doing LSD experiments on unsuspecting individuals, illegal gun running by the BATF (fast and furious) The Tuskegee syphilis study. Now, do I trust the government? That’s a tough one, let me think. The answer is a resounding NO. I trust Walmart more than the U.S. government.

Paul Hsieh

The issue isn’t merely psychological discomfort but privacy. If a doctor wants to promote safe gun practices, they can (and should) do so regardless of whether or not there is a gun in the house — the issue is still relevant regardless of whether one owns a firearm.

Let me start by saying that I don’t believe anybody should own any type of guns and I also don’t believe that shooting fish in a barrel qualifies as hunting or sportsmanship.

That said, I also don’t think physicians should be asking or offering education in gun safety or fire safety or water safety (unless there is an obvious reason, like a gunshot wound), since they have no expertise in these fields. People don’t usually go to doctors (or pay doctors) to examine whether they have a need for a fire extinguisher or a smoke detector or a gun. These are public health issues and should be addressed elsewhere (preferably in Congress IMHO).

Mike_Comments

When my kid’s doctor asked my wife if there was a gun in the house, she told him it was none of his business. When the doctor asked my kid, he said he didn’t know. And we found another doctor.

Your articles makes me sad. I think it is unfortunate that instead of injecting a refreshing breath of good-old-fashioned common sense into this debate, you decided to conflate swimming pools with guns.

Any physician worth their weight in salt would know to take the middle road and use the following tact with a parent by saying, “If you have a gun in your house, it is so important for you to keep it in a safe, unloaded, with a trigger lock on it. Children can get into just about anything – but not a secure gun safe. Think about how terrible you feel when your child scrapes their knee. Think about how you would feel if they had a preventable gun injury. If you have it, lock it up!”

This type of agnostic approach is exactly what physician need to do. Counsel the patient but don’t interrogate them about gun ownership.

Our country has 500% more gun deaths per capita than Turkey. I don’t know about you, but I don’t exactly think of Turkey as a first-world pinnacle of refinement and stability. As an avid hunter and owner of many firearms, I know we have to do a little better in this country with respect to gun violence and gun deaths. Having a physician, like you, offer non-solutions like this is disappointing. You should do better.

Molly_Rn

Michael Brown, your response is superior to the ignorant article. I really don’t think we can have an intelligent discussion in this country about guns because of the lack of good statistics and knowledge about gun violence in the USA. Just came back from Norway and Iceland where they think we are nuts to love guns so much. Norway is still in a state of shock by the slaughter of innocent children by Breivik. I felt totally safe in both countries and didn’t even see much evidence of police (in Norway they keep their weapons locked in the trunk of their car and in iceland they carry batons and pepper spray.)

gwen rothberg

and yet, in a majority of southern and sun state jurisdictions, pool covers, alarms, fences and additional liability insurance is required by law, yet you continue to carry the NRA’s water with enough vigor to try and fill a swimming pool of malarcky all by yourself. The best part about this article is the rebuttal by Michael Brown below.

SBornfeld

So, I see we shall pick and choose between constitutional amendments, by political inclination.
I think maybe you shouldn’t ask your patients about anything they don’t volunteer. Yeah, that’s the ticket.

saraeanderson

Discounting deaths via suicide makes no sense. Not being suicidal now is no guarantee that it won’t happen in the future. Also, who cares if the AAP takes “left” positions on gun control? That means nothing – it’s just tribalism.

All I’m getting from this article is that it hurts’ gun owners’ feelings when they find out that guns are good tools for killing.